Prehospital noninvasive ventilation can help in management of patients with limitations of life-sustaining treatments

Abstract

To evaluate the possible place of noninvasive positive pressure ventilation (NPPV) as a reversible and adjustable option offering the possibility of sustaining life until the hospital stay for patients with advanced life-support limitations and life-threatening respiratory distress in the prehospital setting. Patients managed by a physician-staffed Emergency Medical Service unit were retrospectively included if they met the three inclusion criteria: a respiratory failure with oxygen saturation (pulse oximetry) less than 90% (or respiratory exhaustion) under oxygen 15 l/min and a do-not-intubate discussion (according to the physician on-scene) and impossibility of conducting the discussion of withholding advanced life support on-scene. Twelve patients were included. NPPV was a continuous positive airway pressure for eight patients and a bilevel positive airway pressure given by a ventilator for four patients. All the patients improved from respiratory point of view; respiratory rate decreased from 34 + or - 13 to 27 + or - 10 (P = 0.009) and pulse oximetry increased from 86 + or - 5 to 94 + or - 3% (P<0.01). NPPV was stopped in one case because of discomfort and worsening of consciousness, despite improved respiratory status. This pilot series is promising and suggests that it could be a good option in case of limitations of life-sustaining treatments in the prehospital setting. A large controlled multicenter study, evaluating the use of NPPV in this context, would be very valuable.